What is health equity?
Significant and persistent inequalities in health exist across population groups and communities in Canada. Such inequalities are noted by differences in
- life span
- self- reported health
- rates of disease.
Some of these variations are based in genetics or lifestyle factors, but most differences in health are related to socioeconomic inequality.
The lower you are on the socioeconomic scale, the poorer your health. This is called the health gradient.
In Canada, there is a growing gap between the richest and poorest Canadians. This gap matters: the more unevenly wealth is distributed, the more the health of the entire population suffers.
(Source: The Spirit Level, Richard Wilkinson and Kate Pickett, 2009)
Which groups face the greatest health inequities?
In Ontario, groups facing disproportionate social and health inequities include:
- Aboriginal communities
- People of colour (newcomers to Canada as well as long term Canadian residents and citizens)
- Rural communities
Intersecting factors include such things as disability, immigration status or sexual orientation.
How is equity related to health promotion?
The 1986 Ottawa Charter for Health Promotion names equity as a prerequisite for health, together with social justice
Through the lens of health equity, health promoters have a more nuanced recognition of how the key determinants of health affect different groups, and how policies and programs can reduce inequities. Because most inequities are socially created, rather than the result of individual choices we make, remedies need to address social factors.
In Canada, we need to use a health equity lens to develop effective remedies. Health promoters must ask critical questions informed by health equity at each stage of their work – policy and strategy, designing actions and programs, and implementation and evaluation – so that health can be improved for everyone.
Planning for health equity
Health equity is more than equality of access to services. It also means equality of opportunity for:
- food security
It means inclusion for all. Most importantly, it means improved health for everyone.
Because health can vary across different regions and within groups in the same community, we must understand and address needs at various levels:
- large populations
To achieve health equity, we must combine broad population level approaches with more targeted interventions.
We need data on sub-populations (including race, language, ethnicity, region and neighbourhood) so we can develop appropriate targeted interventions.
It can be difficult to predict how any given program will affect health equity. Assessment tools may help health promoters anticipate likely outcomes at the planning stage itself. Known as Health Equity Impact Assessments, Health Equity Audits, or Health in all Policies, these approaches use health equity analysis to understand how a particular policy or program will influence the distribution of improved health throughout a given population. Such initiatives are relatively recent in Canada, although they have been in use in the UK, Europe, Australia and New Zealand for some time.
Health Nexus is a ‘Champion Organization’ for the Ontario Ministry of Health and Long-term Care’s Health Equity Impact Assessment Tool
Where can you go for more information?
Health Nexus Resources
This literature review provides evidence from the literature on how to embed health equity into organizational capacity. The discussion section provides health promoters and health promotion organizations with evidence to serve as a foundation for tangible health equity activities.
Health Equity and Racialized Groups: A Literature Review (692kB PDF, 2011)
Addressing Health Inequalities for Racialized Communities: A Resource Guide (716kB PDF, 2011)
Primer to Action: Social Determinants of Health. (PDF 954kB, 2008) Toronto, Health Nexus and Ontario Chronic Disease Prevention Alliance. A resource to understand how the Social Determinants of Health impact chronic disease.
Are Widening Income Inequalities Making Canada Less Healthy? Executive Summary (PDF 213KB, 2002) and Full Report (PDF 3.7MB, 2002) Health Determinants Partnership.
- Towards Health Equity - Canadian Approaches to the Health Sector Role
- The State of Health Equity in Ontario
Equity in public health standards: a qualitative document analysis of policies from two Canadian provinces.
Learning Together: Selecting Population Health Status Indicators To Advance Health Equity
- Health Equity: Programs, Projects and Practice
- Why We Need Urban Health Equity Indicators: Integrating Science, Policy, and Community
- Ottawa Charter for Health Promotion
- First Steps to Equity. Ideas and Strategies for Health Equity in Ontario 2008-2010 (PDF)
- The POWER Report - Volume 2: Acheiving health equity in Ontario
- Let’s start a conversation about health…and not talk about health care at all (Canada, 2011)
Unnatural Causes – is inequality making us sick? (USA, 2008)
This documentary series which explores racial and socioeconomic inequalities in health. Includes short video clips on specific health equity topics.